Comments on: Can an Independent Medicare Commission Control Health Care Costs?

By: Jamesk

Jamesk — Fri, 18 Dec 2009 19:08:20 +0000

I take vicodin and oxycodone for the treatment of this disease because the doctor prescribed me after a thorough examination, seek information and findrxonline logically points out that these medicines should be tightly controlled by its high content of codeine and this makes one induces these opioids the use of these pain medications without a prescription.

By: Jack

Jack — Thu, 17 Dec 2009 16:22:22 +0000

As an area that per capita has high medical care usage, McAllen, Texas has been brought up in several articles comparing costs and usage, What is missing is that McAllen, Texas is home to a large migration of ‘winter Texans’ from the northern U.S. and Canada, who because of their age must have a considerable impact on the statistics from that community.

By: Stan Ingman

Stan Ingman — Thu, 17 Dec 2009 14:47:07 +0000

John..
Governor Dean may have a good idea. Do not pass this compromise and then pass real reform in 2010. Would only need 51 votes in Senate. Your insurance buddies would really get nervous then, especially if cost cutting is implemented that you say you are for.

By: John Seater

John Seater — Thu, 17 Dec 2009 02:03:00 +0000

Why tinker with Medicare at all? It is (a) unconstitutional and (b) doomed to fail in exactly the way it now fails because of its incentive structure.

Point (a) is non-trivial. The US Constitution is a commitment device that prevents time inconsistency. Abandoning it is reckless folly. However, we already have done that, so let’s move on to fixing point (b).

If we want to subsidize poor people’s health care, why not abolish Medicare outright and replace it with “health care stamps” for the small expenditures and “health insurance stamps” for the large rare events? The federal food stamp program provides an excellent analogy. That program does not tell poor people what they must buy, does not tell supermarkets what they must sell or what they must charge, and does not tell farmers what they must grow or how they must grow it. It gets poor people fed, but it’s much simpler to administer than Medicare because it does not try to micromanage the health care industry in order to control costs. Wouldn’t doing the same thing with health care subsidies be a whole lot better than the total (and unavoidable) mess that we now have with Medicare?

By: Adrian Murray

Adrian Murray — Wed, 16 Dec 2009 22:36:03 +0000

Why worry about whether or not the IMAB has any teeth or not? The real agency to control health care costs was snuck into the stimulus bill in February. Look up Federal Coordinating Council for Competitive Research. “Competitive research” is a buzz phrase for cost/benefit analysis.

By: Neil H.

Neil H. — Wed, 16 Dec 2009 21:00:31 +0000

John, what you have written seems immensely clear. Why don’t people on Capitol Hill understand this stuff? Are they totally blinded by the idea of trying to control everyone’s behavior from Washington?

By: Bruce

Bruce — Wed, 16 Dec 2009 20:48:10 +0000

All talk about cost control from this Administration is a complete sham. Nobody on the political left has any interest whatsoever in cost control. All they want to do is spend, spend, spend.

By: H.Carroll

H.Carroll — Wed, 16 Dec 2009 20:36:00 +0000

Lot of great stuff in the post and comments. As I have watched the development of these features of the suggested “reform for reform and history’s sake,” one of the more frustrating things is this continued idea that an Independent Medicare Commission will have any impact on true, real prices in health care when the stated purpose is essentially to simply control the Medicare (and Medicaid) BUDGET. If they are successful according to that charge, they may have, indeed, controlled the level of a BUDGET, while having had no impact on the prices of health care services other than to make them GO UP by continually and illegitimately ratcheting down what those programs pay providers, who then look to make it up elsewhere. But, the commission will have performed its political duty of controlling that BUDGET, by golly, and what’s more important than that?

By: Bart

Bart — Wed, 16 Dec 2009 20:07:15 +0000

I like the way you think, Steve.

By: Stephen S.S. Hyde

Stephen S.S. Hyde — Wed, 16 Dec 2009 19:42:08 +0000

John, you provide deep insights into why Medicare’s top-down, command-and-control approach to price and quality controls not only won’t work, but can’t work. In my view, the only way to spread innovative cost and quality improvement throughout the medical system is to empower patients to demand the answers to two questions: 1. Who are the best, most appropriate medical providers for my medical needs? 2. Of the best, which is cheapest?

To get there with Medicare, I think we need at least four fundamental reforms: 1. Covert Medicare to a defined-contribution program in which it gets entirely out of the insurance business and just gives the money to its beneficiaries to buy their own insurance and medical care. 2. Create the conditions under which a universally-available individual insurance market can function with private insurers who are allowed (but not guaranteed) to earn a profit. 3. Redefine minimum insurance benefits to include care that is both medically necessary and normally unaffordable as a regular consumer expense, thus excluding normal doctor visits, most Rx’s, massage therapy, hairpieces, and most lab and x-ray tests. 4. Require Medicare to completely abandon provider price controls.

If you’re interested, this concept is fleshed out in more detail at http://www.hydeonhealthcare.com/role-government-health-care-reform.html.

Many thanks for your innovative thinking for the past 20 years. You’ve made a big difference. Steve Hyde